Pulmonology #6 (Respiratory Infections)

Question 1

What happens if you try to treat children under 18 with Aspirin?

Answer 1

Reye Syndrome!! has a 30% fatality rate

Question 2

Symptoms of influenza

Answer 2

-Abrupt onset of headache, fever, chills, malaise, myalgias (involving legs)
-Dry cough, eye pain, GI symptoms

Question 3

What diagnostics can be done for influenza?

Answer 3

rapid nasal swab or viral cultures

Question 4

Treatment for influenza…

Who gets antivirals?

Answer 4

Supportive: Acetominophen

Antivirals: is hospitalized or 65 years or older
–Oseltamivir within 48 hours of symptom onset (not given under 12 years old)
–If in a long-term facility, all residents get it regardless of vaccine history

Question 5

What are contraindications to BOTH flu vaccines?

Answer 5

Anaphylaxis to vaccine

Guillan-barre Syndrome within 6 weeks after a flu vaccine

High fever

Infants < 6 months of age

Question 6

Who can get the inactivated flu vaccine?

How about the live attenuated vaccine?

Answer 6

Inactivated: 6 months or older (including pregnancy)

Live: 2-49 years old

Question 7

What are contraindications to the live attenuated flu vaccine?

Answer 7

Immunocompromised, pregnancy, 50 years or older, or have taken antivirals within the last 48 hours

Question 8

What are the three phases of Pertussis (Whooping Cough)?

What phase are the children most contagious in?

Who does this normally occur in?

Answer 8

1) Catarrhal Phase: URI symptoms lasting 1-2 weeks
2) Paroxysmal Phase: severe coughing fits with inspiratory whooping after cough. Post-tussive emesis.
3) Convalescent Phase: resolution of cough

Catarrhal most contagious

Children under 2 years old

Question 9

Treatment for Pertussis

Answer 9

-Supportive: oxygen, nebulizer
-Macrolides if needed

Question 10

What is the vaccine schedule for pertussis?

Answer 10

DTap in 5 doses: 2, 4, 6, 15-18 months, 4-6 years old.

Booster at 11-18 years old.

Question 11

What is the MCC of lower respiratory infection in children?

What is the key diagnostic to determine prognosis?

Answer 11

RSV

Pulse oximetry

Question 12

Acute bronchitis is inflammation of the bronchi. It is MCC by ________.

What are some symptoms of this condition?

Answer 12

Viruses

Cough: present for at least 5 days, 1-3 weeks
-Malaise, dyspnea, hemoptysis
-Follows a URI
-Wheezing, Fever

Question 13

How do you prevent acute bronchitis?

What’s the treatment?

Answer 13

H. Flu vaccine

Supportive: fluids, rest, humidifier

Question 14

Acute bronchiolitis is infection of the bronchioles (smaller airways). This is MC in ______ and the MCC is ______

Answer 14

Children under 2 years old

RSV is the MCC

Question 15

Symptoms of acute bronchiolitis

What is the treatment?

Answer 15

Viral prodrome for 1-2 days followed by respiratory distress

Supportive: IVF, humidified oxygen
-Handwashing is preventative

Question 16

What can you give to prevent bronchiolitis?

Answer 16

Palivizumab if born < 29 weeks or has congenital heart disease

Question 17

Acute epiglottitis (Supraglottitis) is MC in _______ and what is the MCC? Remember this cause may have changed due to a vaccine.

What’s another cause in adults?

Answer 17

MC in 3 months - 6 years

H. Influenzae B MCC until vaccines (Hib).

If immunized, suspect Group A Strep

Cocaine is a cause in adults

Question 18

Symptoms of supraglottitis

Answer 18

Dysphagia, Drooling, Distress

-Odynophagia, fever, inspiratory stridor, tripping, hot potato voice
-Refuses to lie supine

Question 19

What is the definitive diagnostic for supraglottitis?

What is seen on XR?

What should you NOT do?

Answer 19

Laryngoscopy: cherry red epiglottis with swelling

Soft tissue lateral cervical XR: thumb or thumbprint sign (enlarged epiglottis)

Do not try to visualize with tongue depressor

Question 20

Treatment for supraglottitis?

Answer 20

Maintain airway first (OR best setting for intubation)

Prevention with Hib vaccine

ABX: Ceftriaxone or Cefotaxime

Question 21

What can you give to close contacts to prevent acute epiglottitis?

Answer 21

Rifampin

Question 22

MCC of Laryngotracheitis (Croup)

Answer 22

Parainfluenza Virus Type 1

Question 23

Symptoms of Croup

Answer 23

-Upper airway involvement (harsh, seal-like barking cough)
-Inspiratory stridor
-Hoarseness
-Low grade fever
-Symptoms worse at night
-Coryza (URI symptoms)

Question 24

What is seen on front cervical radiographs with Croup?

Answer 24

Steeple sign (subglottic narrowing of airway)

Question 25

Treatment for Croup if…

Mild
Moderate
Severe

Answer 25

Mild (no stridor at rest): Supportive, Dexamethasone for symptoms

Moderate (stridor at rest with mild retractions): Dexamethasone and Nebulized Epi

Severe: Dexa + Epi + Hospitalization

Question 26

MC foreign body aspirated by children?

Treatment

Answer 26

Peanuts

Rigid bronchoscopy

Question 27

Costochondritis and Tietze Syndrome are VERY similar in presentation, etiologies, and treatment. What are the etiologies, treatment, and differences in symptoms?

Answer 27

Etiologies: idiopathic, postural or posttraumatic (coughing, straining)

Treatment: NSAIDs

Symptoms: Pleuritic chest pain worse with inspiration. Reproducible point chest wall tenderness with palpation. Palpable edema ONLY in Tietze Syndrome (none in Costochondrititis)

Question 28

What is acute respiratory distress syndrome?

What is the biggest risk factor for this condition?

Answer 28

Severe inflammation of the lung tissue that impairs gas exchange secondary to acute injury –> pulmonary edema –> capillaries get leaky –> oxygen doesn’t transfer within the lungs

Gram-negative Sepsis

Question 29

Symptoms of ARDS

Answer 29

-Acute dyspnea and hypoxemia
-Frothy red sputum
-Tachypnea
-Diffuse crackles
-Severe hypoxemia refractory to suppemental oxygen (Low O2 that doesn’t improve)

Question 30

What diagnostics are done for ARDS?

Answer 30

CXR: diffuse bilateral pulmonary infiltrates (like CHF but spares costophrenic angles)

PCWP < 18mmHg with right heart catheterization (in CHF it is > 18)

Question 31

Treatment for ARDS

Answer 31

-Intubation and PEEP improves hypoxemia

Question 32

What is hyaline membrane disease/Respiratory distress syndrome?

Answer 32

Occurs in premature infants due to insufficient production of surfactant

Question 33

True or False: Hyaline membrane disease is MCC of death in the first month of life?

Answer 33

True

Question 34

By _____, enough surfactant is produced in the lungs.

Symptoms of hyaline membrane disease

Answer 34

35 weeks

-Presents shortly after birth with respiratory distress.
-Tachypnea
-Tachycardia
-Chest wall retractions
-Nasal flaring, cyanosis, respiratory grunting

Question 35

Treatment for hyaline membrane disease

Answer 35

-Antenatal glucocorticoids given if premature birth expected (before 34 weeks)
-Exogenous surfactant via endotracheal tube to open alveoli
-CPAP oxygen +/- intubation

Question 36

Sleep apnea is involuntary cessation of breathing during sleep. Risk factors for this condition include….

There are two types. Explain them.

Answer 36

Obesity***, Males, Older age

Central: reduced CNS respiratory drive

Obstructive: physical airway obstruction

Question 37

Symptoms of sleep apnea

Answer 37

-Snoring, unrestful sleep, hypersomnia, nocturnal choking
-Large neck circumference
-Crowded oropharynx
-Micrognathia (lower jaw undersized)

Question 38

Diagnostics for sleep apnea

Answer 38

-In lab polysomnography (first line): 15 or more events/hour

-Epworth Sleepiness Scale

Question 39

Treatment for sleep apnea

Answer 39

-Behavioral changes: weight loss, no alcohol, changes in position to sleep
-CPAP
-Oral appliances
-Tracheostomy is definitive